One in four pregnancies will end in a miscarriage. There is still a great deal unknown about the causes of miscarriage and it is often diffi cult to pinpoint an exact cause in individual women. It is important to know that it is most unlikely to have been caused by anything you did or did not do.
Miscarriage is the term used to describe the spontaneous loss of a baby. This can occur at anytime, from around the date of a missed period, to 24 weeks of pregnancy (after 24 weeks the loss of a baby is referred to as a stillbirth and is registered as a birth). A miscarriage can be a very distressing time. Apart from the emotional trauma of expecting a baby and then losing it, your body has been adapting to the changes of pregnancy. Your hormone levels will fall suddenly and the lining of your womb, including the blood supply which has been supporting the pregnancy, will be lost.
This is when there is spotting or bleeding. However many women do not go on to miscarry and the bleeding may settle and stop. This bleeding can be caused by hormones, particularly around the time of the missed period at 8 and 12 weeks.
Missed miscarriage or delayed miscarriage
Often a pregnancy comes to an end with little or no sign that anything is wrong. The baby dies or fails to develop, but your body does not expel the pregnancy. You may hear medical staff use the term ‘early foetal demise’, which means that the baby has died in the womb at an early gestational age.
Blighted ovum
This is the name given to a fertilised egg that does not divide and develop as it should. The normal pregnancy sac develops but the baby fails to develop within the sac. Incomplete miscarriage This happens when the pain and bleeding of miscarriage continue, but not all of the pregnancy tissue is expelled.
Inevitable miscarriage
This is when the pain and bleeding of a miscarriage continue and increase. The cervix will open and the pregnancy will be lost.
Complete miscarriage
This means the pregnancy has ended and all the pregnancy tissue in the womb has come away and is lost.
Late miscarriage
After 14 weeks, a scan may reveal the baby has died or the pregnancy begins to be lost. You may experience painful contractions, dilation of the cervix, bleeding, and the water sac surrounding the baby may rupture (break).
Hydatidiform mole
In rare cases (1 in 1200 pregnancies) an abnormal egg cell is fertilised and develops for a while as if it were a normal pregnancy, but only the placenta develops; there is no embryo. The hormones of pregnancy are produced which make a woman feel pregnant. This type of pregnancy will be picked up by a scan. Once diagnosed, specialised follow-up care is essential and you will be referred to a specialised centre in the UK.
Ectopic pregnancy
An ectopic pregnancy is a pregnancy outside the womb. About 1 in 100 pregnancies is ectopic. 95% of ectopic pregnancies occur in one of the fallopian tubes. Signs of an ectopic pregnancy include pain and bleeding. The bleeding can be a scanty irregular brown / red discharge. Pain in the shoulder or rectum can also be a symptom. An ectopic pregnancy is usually caused by a problem with the fallopian tubes, and not the developing baby.
If you have a threatened miscarriage, your GP should refer you to our Gynaecology Emergency Unit (GEU) Unit for the gynaecology doctor to review and arrange a scan. A scan will not be carried out until after the sixth week of pregnancy. Often it is diffi cult in early pregnancy to detect the baby’s heartbeat and a second scan will be offered to you a week later.
An internal vaginal examination is not usually required at this stage, but in some circumstances the doctor may wish to examine your cervix (neck of the womb). This will not cause any harm to the pregnancy. The doctor may take a swab to exclude any infection. We realise that, because of the time needed to make a clear assessment, you may feel anxious as you remain uncertain about the progress of your pregnancy.
Miscarriage if you are less than 12 weeks pregnant
To diagnose a miscarriage, you will have a full examination and an ultrasound scan. This may be a shock, as you may still feel pregnant. You will fully miscarry with time; however there are different ways to manage the situation:
Expectant management
You may be given the option of returning home to let nature take its course, and the loss to occur naturally. This is called expectant management. This is one of the preferred methods of treating a miscarriage when the baby is less than 12 weeks gestation.
This method will be selected when:
Miscarriage is the term used to describe the spontaneous loss of a baby. This can occur at anytime, from around the date of a missed period, to 24 weeks of pregnancy (after 24 weeks the loss of a baby is referred to as a stillbirth and is registered as a birth). A miscarriage can be a very distressing time. Apart from the emotional trauma of expecting a baby and then losing it, your body has been adapting to the changes of pregnancy. Your hormone levels will fall suddenly and the lining of your womb, including the blood supply which has been supporting the pregnancy, will be lost.
What causes a miscarriage?
In 60% of cases, a miscarriage before the 12th week of pregnancy is likely to be because of an abnormality of the growing baby. However, it is often very diffi cult to determine the cause. Many women are left asking questions, and fi nd it hard to accept that no cause can be given. Please be reassured, it is unlikely to have been caused by anything you did.Types of miscarriage
Threatened miscarriageThis is when there is spotting or bleeding. However many women do not go on to miscarry and the bleeding may settle and stop. This bleeding can be caused by hormones, particularly around the time of the missed period at 8 and 12 weeks.
Missed miscarriage or delayed miscarriage
Often a pregnancy comes to an end with little or no sign that anything is wrong. The baby dies or fails to develop, but your body does not expel the pregnancy. You may hear medical staff use the term ‘early foetal demise’, which means that the baby has died in the womb at an early gestational age.
Blighted ovum
This is the name given to a fertilised egg that does not divide and develop as it should. The normal pregnancy sac develops but the baby fails to develop within the sac. Incomplete miscarriage This happens when the pain and bleeding of miscarriage continue, but not all of the pregnancy tissue is expelled.
Inevitable miscarriage
This is when the pain and bleeding of a miscarriage continue and increase. The cervix will open and the pregnancy will be lost.
Complete miscarriage
This means the pregnancy has ended and all the pregnancy tissue in the womb has come away and is lost.
Late miscarriage
After 14 weeks, a scan may reveal the baby has died or the pregnancy begins to be lost. You may experience painful contractions, dilation of the cervix, bleeding, and the water sac surrounding the baby may rupture (break).
Hydatidiform mole
In rare cases (1 in 1200 pregnancies) an abnormal egg cell is fertilised and develops for a while as if it were a normal pregnancy, but only the placenta develops; there is no embryo. The hormones of pregnancy are produced which make a woman feel pregnant. This type of pregnancy will be picked up by a scan. Once diagnosed, specialised follow-up care is essential and you will be referred to a specialised centre in the UK.
Ectopic pregnancy
An ectopic pregnancy is a pregnancy outside the womb. About 1 in 100 pregnancies is ectopic. 95% of ectopic pregnancies occur in one of the fallopian tubes. Signs of an ectopic pregnancy include pain and bleeding. The bleeding can be a scanty irregular brown / red discharge. Pain in the shoulder or rectum can also be a symptom. An ectopic pregnancy is usually caused by a problem with the fallopian tubes, and not the developing baby.
Miscarriage Treatments Options
Threatened miscarriageIf you have a threatened miscarriage, your GP should refer you to our Gynaecology Emergency Unit (GEU) Unit for the gynaecology doctor to review and arrange a scan. A scan will not be carried out until after the sixth week of pregnancy. Often it is diffi cult in early pregnancy to detect the baby’s heartbeat and a second scan will be offered to you a week later.
An internal vaginal examination is not usually required at this stage, but in some circumstances the doctor may wish to examine your cervix (neck of the womb). This will not cause any harm to the pregnancy. The doctor may take a swab to exclude any infection. We realise that, because of the time needed to make a clear assessment, you may feel anxious as you remain uncertain about the progress of your pregnancy.
Miscarriage if you are less than 12 weeks pregnant
To diagnose a miscarriage, you will have a full examination and an ultrasound scan. This may be a shock, as you may still feel pregnant. You will fully miscarry with time; however there are different ways to manage the situation:
Expectant management
You may be given the option of returning home to let nature take its course, and the loss to occur naturally. This is called expectant management. This is one of the preferred methods of treating a miscarriage when the baby is less than 12 weeks gestation.
This method will be selected when:
- An ultrasound scan has confirmed your pregnancy is no longer viable (no longer capable of maintaining life).
- You are not bleeding heavily.
- You are less than 12 weeks pregnant.
- You are otherwise generally well, and not experiencing signs of shock, dizziness, nausea, vomiting or severe pain.
- There is no evidence of infection.
- There is no evidence of anaemia.
- You have / may have medical disorders, which may be complicated by an anaesthetic.
